• Title/Summary/Keyword: 후방 도달법

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The Optimal Surgical Approach and Complications in Resecting Osteochondroma around the Lesser Trochanter (소전자부 주위의 골연골종 절제 시 적절한 외과적 접근법과 합병증)

  • Jeon, Dae-Geun;Cho, Wan Hyeong;Song, Won Seok;Kong, Chang-Bae;Lee, Seung Yong;Kim, Do Yup
    • Journal of the Korean Orthopaedic Association
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    • v.52 no.1
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    • pp.33-39
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    • 2017
  • Purpose: Surgical risks associated with the resection of osteochondroma around the proximal tibia and fibula, as well as the proximal humerus have been well established; however, the clinical presentation and optimal surgical approach for osteochondroma around the lesser trochanter have not been fully addressed. Materials and Methods: Thirteen patients with osteochondroma around the lesser trochanter underwent resection. We described the chief complaint, duration of symptom, location of the tumor, mass protrusion pattern on axial computed tomography image, tumor volume, surgical approach, iliopsoas tendon integrity after resection, and complication according to the each surgical approach. Results: Pain on walking or exercise was the chief complaint in 7 patients, and numbness and radiating pain in 6 patients. The average duration of symptom was 19 months (2-72 months). The surgical approach for 5 tumors that protruded postero-laterally was postero-lateral (n=3), anterior (n=1), and medial (n=1). All 4 patients with antero-medially protruding tumor underwent the anterior approach. Two patients with both antero-medially and postero-laterally protruding tumor received the medial and anterior approach, respectively. Two patients who underwent medial approach for postero-laterally protruded tumor showed extensive cortical defect after resection. One patient who received the anterior approach to resect a large postero-laterally protruded tumor developed complete sciatic nerve palsy, which was recovered 6 months after re-exploration. Conclusion: For large osteochondromas with posterior protrusion, we should not underestimate the probability of sciatic nerve compression. When regarding the optimal surgical approach, the medial one is best suitable for small tumors, while the anterior approach is good for antero-medial or femur neck tumor. For postero-laterally protruded large tumors, posterior approach may minimize the risk of sciatic nerve palsy.

Resection and Reconstruction for Liposarcoma Involving Popliteal Fossa and Antero-lateral Compartment of Lower Leg - A Case Report - (하퇴 슬와부 및 전외측 구획을 침범한 지방육종 환자의 절제 및 재건술 - 증례보고 -)

  • Won, Ho-Hyun;Hong, Youn-Seok;Jeon, Dae-Geun
    • The Journal of the Korean bone and joint tumor society
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    • v.15 no.1
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    • pp.69-74
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    • 2009
  • Soft tissue sarcomas of popliteal fossa are rare, accounting for less than 5% of all soft tissue sarcomas of the extremities. In an extracompartmental space such as the popliteal, cubital fossa and inguinal space, where major vessels and nerves traverse, performing resections with wide margin is difficult and sometimes marginal margin is inevitable for limb salvage. For popliteal tumor resection, posterior approach would be a classic method. For tumors with small size and not adherent to surrounding structures, tumor is easily resected by this approach and dissection of nerve sheath or adventitia of vessel. On the contrary, tumors of large size and infiltrating the posterior structure of knee joint may show difficulty in en-bloc resection itself. These cases were candidates for amputation. Furthermore, tumors involving both popliteal fossa and anterior compartment usually had no choice but to have an amputation to prevent local recurrence. We regarded soft tissue sarcoma showing this kind of presentation as bone tumor having extraosseous mass. We performed wide en-bloc resection of proximal tibia and fibula along with sarcoma involving both compartment on liposarcoma of 47-year old man.

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The Open Surgical Treatment for Stiff Elbow (주관절 구축의 관혈적 치료)

  • Lee, Ji-Ho;Ra, In-Hoo;Jeon, In-Ho
    • Clinics in Shoulder and Elbow
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    • v.13 no.2
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    • pp.293-298
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    • 2010
  • Purpose: Since an injured elbow joint can disturb the activity of daily life by limiting motion, especially if the motion is restricted over 40 degree of flexion contracture and under 105 degree of further flexion, it is imperative to select the best method and the timing of treatment of the elbow stiffness. Therefore this review will discuss open surgical techniques for stiff elbows based on the literature. Materials and Methods: It is important to take sufficient clinical examination of the patient, including history taking. And, a surgeon should select appropriate procedure after accurately understanding about the status and cause of the stiff elbow with radiographic methods. Surgical methods include arthroscopic release open release, distraction arthroplasty, total elbow replacement and there are four approachs in the open release - anterior approach, medial "over the top" approach, limited lateral approach: column procedure, posterior extensile approach-. Results and Conclusion: Although at present the arthroscopic technique is emphasized for the treatment of elbow stiffness, a surgeon should know conventional open techniques.

Intra-articular Giant Cell Tumor of Tendon Sheath Arising from Posterior Cruciate Ligament - Arthroscopic Excision Using Posterior Trans-septal Portal - (후방 십자 인대에서 발생한 건초성 거대 세포종 - 후격막 통과 도달법을 이용한 관절경적 절제 -)

  • Ahn, Jin Hwan;Seo, Jai Gon;Ha, Chul Won
    • Journal of the Korean Arthroscopy Society
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    • v.2 no.1
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    • pp.97-100
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    • 1998
  • The giant cell tumor of tendon sheath is very rarely present inside the knee joint. The authors report a case of intraarticular giant cell tumor of tendon sheath arising from posterior cruciate ligament which was successfully excised arthroscopically using posterior trans-septal portal at the time of arthroscopic reconstruction of anterior cruciate ligament.

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Long-Term Results of Surgical Treatment for Sacral Chordoma (천추 척색종의 수술적 치료 후 장기 추시 결과)

  • Chung, Jae-Yoon;Lee, Jae-Joon;Seo, Hyoung-Yeon;Jung, Sung-Taek
    • The Journal of the Korean bone and joint tumor society
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    • v.11 no.2
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    • pp.148-154
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    • 2005
  • Purpose: To evaluate the long term results of surgical treatment for sacral chordoma. Material and Method: We reviewed the records of 4 patients with sacral tumor treated surgical resection. Mean follow-up duration was 8.3 year(3~11). All cases were performed complete resection of tumor mass through posterior approach in 3 cases and anterior-posterior approach in one. The most caudad nerve-roots spared were the second sacral roots in one and the third sacral roots in 3 cases. Functions of voiding and defecation including neurological symptoms of lower extremities, other complications of surgical treatment, and local recurrence or distant metastasis of tumor were evaluated. Result: There was no motor deficit in all cases, but radiating pain was developed in one and wound infection in one. Bladder function was preserved in 2 cases, intermittent incontinence in one, and doing intermittent catheterization in one. Bowel function was preserved in one and 2 cases were suffered from constipation. At the last follow-up, disease-free was in one, local recurrence in one, and local recurrence with distant metastasis in one. Conclusion: The result of surgical resection for sacral chordoma is satisfactory showing average 8 years survival. Early detection and aggressive surgical treatment is the best to prolong survival and to minimize functional deficit with preservation of upper sacral nerves.

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An Analysis on Hydrologic Characteristics of Design Rainfall for the Design of Hydraulic Structure (수공구조물 설계를 위한 설계강우의 수문학적 특성 분석)

  • Lee, Jeong-Sik;Lee, Jae-Jun;Park, Jong-Yeong
    • Journal of Korea Water Resources Association
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    • v.34 no.1
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    • pp.67-80
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    • 2001
  • This study is to propose temporal pattern of design rainfall which causes maximum peak discharge and to analyze the variation in peak discharge according to design rainfall durations. In this study, the Mononobe, the Yen and Chow triangular, the Huff's 4th quartiles and the Keifer and Chu methods are applied to estimate the proper temporal pattern of design rainfall and three rainfall-runoff models such as SCS, Nakayasu, and Clark methods are used to estimate the runoff hydrograph. And to examine the variability of peak discharge, the hydrologic characteristics from the rainfall-runoff models to which uniform rainfall intensity is applied are used as the standard values. The type of temporal pattern of design rainfall which causes maximum peak discharge in both of the watersheds and the rainfall-runoff models has resulted in Yen and Chow distribution method with the dimensionless vague of 0.75. On the basis of determined temporal pattern, the examination of the variability of peak discharge according to design rainfall durations shows that design rainfall duration varies greatly with the types of probable intensity formula, and the variation of peak discharge is more affected by the types of probable intensity formula and I-D-F currie than rainfall-runoff models.

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Study on the Thruster Plume Behaviors using Preconditioned Scheme and DSMC Method (예조건화 기법과 직접모사법을 이용한 추력기 플룸 거동에 관한 연구)

  • Lee, Kyun-Ho;Kim, Su-Kyum;Yu, Myoung-Jong
    • Aerospace Engineering and Technology
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    • v.8 no.1
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    • pp.144-153
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    • 2009
  • To study the plume effects in the rarefied region, the Direct Simulation Monte Carlo(DSMC) method is usually adopted because the plume field usually contains the entire range of flow regime from the near-continuum in the vicinity of nozzle exit through transitional state to free molecular at far field region from the nozzle. The objective of this study is to investigate the behaviors of a small monopropellant thruster plume in the rarefied region numerically using DSMC method. To deduce accurate results efficiently, the preconditioned scheme is introduced to calculate continuum flow fields inside thruster to predict nozzle exit properties used for inlet conditions of DSMC method. By combining these two methods, the rarefied flow characteristics of plume such as strong nonequilibrium near nozzle exit, large back flow region, etc, can be investigated.

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Study on Small Thruster Plume using Preconditioned Continuum Scheme and DSMC Method in Vaccum Area (희박영역에서 예조건화 연속체기법과 직접모사법을 이용한 소형 추력기 플룸 거동에 관한 연구)

  • Lee, Kyun-Ho;Lee, Sung-Nam
    • Journal of the Korean Society for Aeronautical & Space Sciences
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    • v.37 no.9
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    • pp.906-915
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    • 2009
  • To study the plume effects in the vacuum area, the Direct Simulation Monte Carlo(DSMC) method is usually adopted because the plume field usually contains the entire range of flow regime from the near-continuum in the vicinity of nozzle exit through transitional state to free molecular at far field region from the nozzle. The objective of this study is to investigate the behaviors of a small monopropellant thruster plume in the vacuum area numerically using DSMC method. To deduce accurate results efficiently, the preconditioned scheme is introduced to calculate continuum flow fields inside thruster to predict nozzle exit properties used for inlet conditions of DSMC method. By combining these two methods, the vacuum flow characteristics of plume such as strong nonequilibrium near nozzle exit, large back flow area, etc, can be investigated.

Limited Posterior Approach for the Surgical Treatment of Intraarticular Fracture of Calcaneus (제한적 후방 도달법을 이용한 관절내 종골 골절의 치료)

  • Hyun, Yun-Seok;Song, Kyung-Won;Shin, Sung-Il;Lee, Jin-Young;Lee, Seung-Young;Kim, Gab-Lae;Shin, Kun-Ho;Seo, Eun-Ho;Ban, Tae-Seo
    • Journal of Korean Foot and Ankle Society
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    • v.11 no.1
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    • pp.79-85
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    • 2007
  • Purpose: To evaluate the clinical efficacy of the limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus. Materials and Methods: From March 2000 to February 2006, we studied retrospectively 186 patients, 203 cases who were treated with open reduction and internal fixation through limited posterior approach and were followed up for more than 1 year. The clinical results were evaluated with Creighton-Nebraska score and circle draw test after 1 year. We checked simple AP, lateral, axial and Broden's view preoperatively and 1 year after surgery, and compared $B{\ddot{o}}hler$ angle and Gissane angle. Results: By Creighton-Nebraska score, Sanders type 2 was 86.4, type 3 was 74.3, type 4 was 62.4. And by circle draw test, type 2 was 8.9 cm, type 3 was 7.2 cm, type 4 was 5.9 cm. $B{\ddot{o}}hler$ angle and Gissane angle were $7.6^{\circ}$, $102.4^{\circ}$, and it increased to $23.5^{\circ}$, $128.6^{\circ}$ after postoperative 1 year. Conclusion: Limited posterior approach for the surgical treatment of intraarticular fracture of calcaneus was considered to an effective treatment modality.

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Intradural Schwannoma Associated with Lumbar Spinal Stenosis: A Cese Report (요추부 척추관 협착증과 동반된 경막내 신경초종: 증례 보고)

  • Soh, Jae-Wan;Kim, Tae-Heon;Kwon, Sai-Won
    • The Journal of the Korean bone and joint tumor society
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    • v.17 no.2
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    • pp.106-110
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    • 2011
  • In the patient who has intradural mass associated with spinal stenosis, if the operation for spinal stenosis is performed alone, the symptom may remain. We report with literature review that we achieved the successful outcome after simultaneous decompression of spinal stenosis and space occupying mass removal in the case of intradural and extradural compression. A 71-year-old female patient suffering from low back pain and radiating pain of both lower extremities admitted. In magnetic resonance imaging, spinal stenosis on L4-5 and spondylolisthesis on L5-S1 compressed dural sac and intradural space occupying mass on L4 level compressed. By posterior approach, decompression and interbody fusion were carried out. Then mass was removed with median durotomy. Pathologic diagnosis was schwannoma and the symptom was improved remarkably.